Provider Demographics
NPI:1760611826
Name:SMITTIE, ANDREA (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SMITTIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CULZEAN DR
Mailing Address - Street 2:APT 1412
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-4527
Mailing Address - Country:US
Mailing Address - Phone:937-520-8911
Mailing Address - Fax:
Practice Address - Street 1:5950 CULZEAN DR
Practice Address - Street 2:APT 1412
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-4527
Practice Address - Country:US
Practice Address - Phone:937-520-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123279 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse